Background Quantitative flow ratio(QFR)based lesion selection for percutaneous coronary intervention(PCI)treatment has shown clinical benefits in terms of reduced risk for myocardial infarction and repeat revasculariz...Background Quantitative flow ratio(QFR)based lesion selection for percutaneous coronary intervention(PCI)treatment has shown clinical benefits in terms of reduced risk for myocardial infarction and repeat revascularization.Whether this benefit is consistent across different age groups still needs further investigation.Methods In this prespecified subgroup study of FAVORⅢChina trial,we compared long-term clinical outcomes between QFR-guided and angiography-guided PCI among different age groups among 3825 enrolled subjects.The primary endpoint was major adverse cardiac events(MACEs),a composite of all-cause death,myocardial infarction,and ischemia-driven revascularization.Results Of the 3825 patients,1717(44.9%)were aged≥65 years.At baseline,patients≥65 had higher rates of hypertension,hyperlipidaemia,stroke history(P<0.0001),and peripheral vascular disease(P=0.024)and had higher SYNTAX scores(P=0.0095).Compared with standard angiography guidance,the QFR-guided strategy consistently reduced the 1-year(≥65 years,6.04%vs.9.19%,HR=0.65,95%CI:0.46–0.92;<65 years,5.53%vs.8.43%,HR=0.65,95%CI:0.47–0.91)and 3-year MACE rates in both age groups(≥65 years,11.8%vs.15.2%,HR:0.75,95%CI:0.58–0.98;<65 years,9.5%vs.14.6%,HR=0.63;95%CI:0.49–0.81),without a significant interaction(Pinteraction=0.99).Within the QFR-guided group,the 3-year MACE rate in patients with deferred vessels was numerically greater in patients aged≥65 years than in those aged<65 years(8.3%vs.3.0%,P=0.10).Conclusions Although with higher rate of comorbidities and more complex coronary anatomy,the long-term benefit of the QFR-guided PCI strategy remained consistent in patients≥65 years,compared with those<65 years.展开更多
Anticoagulation is imperative to reduce the incidence of thrombotic complications in patients undergoing percutaneous interventional cardiovascular procedures;however,this is at the expense of increased risk of bleedi...Anticoagulation is imperative to reduce the incidence of thrombotic complications in patients undergoing percutaneous interventional cardiovascular procedures;however,this is at the expense of increased risk of bleeding.The optimal anticoagulation strategy for these procedures remains unclear.Unfractionated heparin is the most commonly used anticoagulant during interventional procedures,but has several limitations,such as relatively high incidence of bleeding events,occurrence of heparin-induced thrombocytopenia,and a paradoxical thrombotic effect.Contemporary studies have demonstrated that bivalirudin decreases the occurrence of bleeding complications,but potentially increases the risk of acute stent thrombosis.This review discusses the pharmacology of bivalirudin and its current clinical application in patients undergoing percutaneous coronary intervention and transcatheter aortic valve replacement procedures.展开更多
The protective role of(poly)phenols against metabolic disorders has been extensively studied in adults but not in adolescents.To assess associations of dietary(poly)phenols and their subclasses with cardiometabolic he...The protective role of(poly)phenols against metabolic disorders has been extensively studied in adults but not in adolescents.To assess associations of dietary(poly)phenols and their subclasses with cardiometabolic health parameters in adolescents.A cross-sectional study was conducted in 944 individuals aged 11–14 years enrolled in the SI!Program for Secondary Schools trial(NCT03504059).(Poly)phenol intake was assessed using semiquantitative food frequency questionnaires and the Phenol-Explorer database.The measured cardiometabolic parameters were waist circumference(WC)age-sex Z-score,blood pressure(BP)age-sex Z-score,blood glucose(BG),triglycerides(TG),and high-density lipoprotein cholesterol(HDL-c).Multilevel mixedeffect linear regression models were applied to examine the association between(poly)phenol quintiles and cardiometabolic health parameters.Compared to the lowest quintile,adolescents in the highest quintile of total(poly)phenol intake had lower WC Z-scores,mean arterial pressure Z-scores,and HDL-c after multivariable adjustment.The WC Z-scores and HDL-c were lower in the highest quintile of flavonoid intake compared to the lowest quintile.The highest quintile of phenolic acid intake was associated with a lower WC Z-score and TG levels,and the highest quintile of stilbene intake with lower BG and TG,and with higher HDL-c compared to the lowest quintile.A higher intake of(poly)phenols,especially flavonoids,phenolic acids,and stilbenes,was associated with better cardiometabolic parameters in adolescents.展开更多
文摘Background Quantitative flow ratio(QFR)based lesion selection for percutaneous coronary intervention(PCI)treatment has shown clinical benefits in terms of reduced risk for myocardial infarction and repeat revascularization.Whether this benefit is consistent across different age groups still needs further investigation.Methods In this prespecified subgroup study of FAVORⅢChina trial,we compared long-term clinical outcomes between QFR-guided and angiography-guided PCI among different age groups among 3825 enrolled subjects.The primary endpoint was major adverse cardiac events(MACEs),a composite of all-cause death,myocardial infarction,and ischemia-driven revascularization.Results Of the 3825 patients,1717(44.9%)were aged≥65 years.At baseline,patients≥65 had higher rates of hypertension,hyperlipidaemia,stroke history(P<0.0001),and peripheral vascular disease(P=0.024)and had higher SYNTAX scores(P=0.0095).Compared with standard angiography guidance,the QFR-guided strategy consistently reduced the 1-year(≥65 years,6.04%vs.9.19%,HR=0.65,95%CI:0.46–0.92;<65 years,5.53%vs.8.43%,HR=0.65,95%CI:0.47–0.91)and 3-year MACE rates in both age groups(≥65 years,11.8%vs.15.2%,HR:0.75,95%CI:0.58–0.98;<65 years,9.5%vs.14.6%,HR=0.63;95%CI:0.49–0.81),without a significant interaction(Pinteraction=0.99).Within the QFR-guided group,the 3-year MACE rate in patients with deferred vessels was numerically greater in patients aged≥65 years than in those aged<65 years(8.3%vs.3.0%,P=0.10).Conclusions Although with higher rate of comorbidities and more complex coronary anatomy,the long-term benefit of the QFR-guided PCI strategy remained consistent in patients≥65 years,compared with those<65 years.
文摘Anticoagulation is imperative to reduce the incidence of thrombotic complications in patients undergoing percutaneous interventional cardiovascular procedures;however,this is at the expense of increased risk of bleeding.The optimal anticoagulation strategy for these procedures remains unclear.Unfractionated heparin is the most commonly used anticoagulant during interventional procedures,but has several limitations,such as relatively high incidence of bleeding events,occurrence of heparin-induced thrombocytopenia,and a paradoxical thrombotic effect.Contemporary studies have demonstrated that bivalirudin decreases the occurrence of bleeding complications,but potentially increases the risk of acute stent thrombosis.This review discusses the pharmacology of bivalirudin and its current clinical application in patients undergoing percutaneous coronary intervention and transcatheter aortic valve replacement procedures.
基金supported by the SHE Foundation,“la Caixa”Foundation(LCF/PR/CE16/10700001)the Fundacióla Maratóde TV3(grant number 369/C/2016)and by the funding from Idilia Foods(FBG 311240)+6 种基金Support was also provided by the Ministerio de Ciencia,Innovación y Universidades(PID2020-114022RB-I00)CIBEROBN from the Instituto de Salud Carlos III,ISCIII from the Ministerio de Ciencia,Innovación y Universidades,(AEI/FEDER,UE)Generalitat de Catalunya.J.Martínez-Gómez is a postgraduate fellow of the Ministerio de Ciencia e Innovación of Spain at the Residencia de Estudiantes(2020–ongoing)R.F-J is a recipient of grant PI19/01704 funded by the Fondo de Investigación Sanitaria-Instituto de Salud Carlos III(ISCIII)co-funded by the European Regional Development Fund/European Social Fund“A way to make Europe”/“Investing in your future”.The CNIC is supported by the ISCIII,the Ministerio de Ciencia e Innovación(MCIN)and the Pro CNIC Foundation,and is a Severo Ochoa Center of Excellence(CEX2020-001041-S funded by MICIN/AEI/10.13039/501100011033)G.Santos-Beneit is the recipient of grant LCF/PR/MS19/12220001 funded by“la Caixa”Foundation(ID 100010434)A.Tresserra-Rimbau is a Serra Húnter Fellow.E.P.Laveriano-Santos is a FI-SDUR(EMC/503/2021)fellow from the Generalitat de Catalunya.
文摘The protective role of(poly)phenols against metabolic disorders has been extensively studied in adults but not in adolescents.To assess associations of dietary(poly)phenols and their subclasses with cardiometabolic health parameters in adolescents.A cross-sectional study was conducted in 944 individuals aged 11–14 years enrolled in the SI!Program for Secondary Schools trial(NCT03504059).(Poly)phenol intake was assessed using semiquantitative food frequency questionnaires and the Phenol-Explorer database.The measured cardiometabolic parameters were waist circumference(WC)age-sex Z-score,blood pressure(BP)age-sex Z-score,blood glucose(BG),triglycerides(TG),and high-density lipoprotein cholesterol(HDL-c).Multilevel mixedeffect linear regression models were applied to examine the association between(poly)phenol quintiles and cardiometabolic health parameters.Compared to the lowest quintile,adolescents in the highest quintile of total(poly)phenol intake had lower WC Z-scores,mean arterial pressure Z-scores,and HDL-c after multivariable adjustment.The WC Z-scores and HDL-c were lower in the highest quintile of flavonoid intake compared to the lowest quintile.The highest quintile of phenolic acid intake was associated with a lower WC Z-score and TG levels,and the highest quintile of stilbene intake with lower BG and TG,and with higher HDL-c compared to the lowest quintile.A higher intake of(poly)phenols,especially flavonoids,phenolic acids,and stilbenes,was associated with better cardiometabolic parameters in adolescents.
